The fact that pharmacy enhanced services are offered to contractors on a postcode lottery basis comes as no real surprise. But while we would expect appalling figures from the underperforming trusts, whittle things down to the average PCT and the figures are still upsetting – they are spending just under £5,000 per year annually on enhanced services at each pharmacy.
Pharmacy financial experts agree this is simply not good enough given the investment required to offer services, often in terms of both training and equipment.
Umesh Modi, partner at accountancy firm Silver Levene, says many pharmacies will be losing money and businesses that have taken on extra pharmacists to provide services will be hit especially hard.
“A day per week of a second pharmacist costs around £10,000 [annually], not to mention the cost of management time and extra floor space allocated to provide such services. I would estimate that the total additional cost per annum is £20,000, so the pharmacist would need around £30,000 of services income to make it worthwhile,” Mr Modi adds.
Andy Harwood, director of business development at pharmacy finance company Pharmacy Partners, agrees: “Pharmacists have spent money on consultation rooms and how many of those are being used all the time for services?”
He says consultation rooms could cost between £6,000 and £8,000 to install, so for some the investment just will not have been worth it.
Further pressures are coming from recently announced category M hits, and Mr Harwood says as money is being taken out of drug reimbursement it is disappointing not to see trusts putting that back into community pharmacy. He asks: “Where are pharmacists supposed to make up the difference?”
Mimi Lau, Numark’s director of professional services, agrees: “What we signed up to in the contract was that a category M mechanism would put money back into services, but looking at these figures some contractors are benefiting from this and some aren’t. This is unfair.”
Even where services are being offered, there is concern about ongoing funding. Mandeep Mudhar, head of NHS development at the Co-operative Pharmacy, says where services do exist the challenge is always “securing the continuing provision and funding”.
“We could put a lot of time and investment into the service in terms of pharmacist training and development, but we need to ensure there is longevity in those services,” he warns.
Pilots can be a particular frustration. As Salim Jetha, CEO at buying group Avicenna, says: “We seem to spend a hell of a lot of money doing trials – if other PCTs have done similar work, use their data and come to a speedy conclusion.”
But aside from sharing data, where do we go from here?
The answer must come from nationally agreed enhanced services, experts and pharmacy bodies agree. National services would mean fairer pay and could mean that all pharmacies can deliver the services, eliminating another spending problem.
As Mr Jetha points out: “Within each PCT, services are only offered to a handful of contractors and not to all willing providers. In some cases it’s the same few, merely because they open longer hours. I believe all patients have rights to services and that they should be available to all contractors.”
To get this resolution, all eyes have turned to PSNC. Ms Lau says the committee and the Department of Health must make it a priority to address this, and Mr Harwood says that, while clinical services were presented some time ago as “PSNC’s big idea”, things have not developed adequately in the real world.
“Ultimately PSNC needs to push for this – they pushed for this contract and we’re not getting anywhere near what we should be from it,” he says.
PSNC’s head of NHS services Alastair Buxton says such national funding is very much on the committee’s agenda. And indeed negotiations on some, such as a first prescription service for patients with long-term conditions, are ongoing. But Mr Buxton warns the challenge is great, especially given how small enhanced service income is relative to overall turnover at the moment.
“There’s got to be a huge change to move to a position where enhanced services form a substantial amount of funding and give significant financial incentives,” he says.
It seems things are moving in the right direction, at least, but timeliness could also be vital, as NHS changes to commissioning could cause further problems. As James Lindsay, head of corporate relations at AAH, says: “There is also the risk that [some] schemes could fall victim to budget cuts or inaction as PCTs transition their responsibilities to GP-led consortia.”
So contractors and the rest of the sector will have to hope some agreements on national services are reached sooner rather than later.